In men: Exogenous testosterone (TRT, anabolic steroids) is the most common cause of high total testosterone. Endogenous causes include androgen-secreting testicular or adrenal tumors, congenital adrenal hyperplasia, and conditions such as hyperthyroidism that can raise SHBG and increase total testosterone without necessarily increasing free testosterone.
In women: PCOS is the most common cause of androgen excess and may cause elevated testosterone. Other causes include nonclassic or classic congenital adrenal hyperplasia, androgen-secreting ovarian or adrenal tumors, Cushing syndrome, ovarian hyperthecosis, and exogenous androgen use.



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